<!DOCTYPE html>
<html lang="en">
<head>
	<meta charset="utf-8">
	<title>Passenger Details - H!Indonesia</title>
	<meta name="description" content="">
	<meta name="keywords" content="" />
	<meta name="author" content="Telkom RDC">
	<meta name="robots" content="index, follow">
	<meta name="viewport" content="width=device-width, initial-scale=1.0">

	<meta content="text/html; charset=utf-8" http-equiv="Content-Type">
	<script type="text/javascript" src="script/jquery-1.9.1.js"></script>
	<script type="text/javascript" src="script/plugins/jquery.tipsy.js"></script>
	<script type="text/javascript" src="script/plugins/jquery.fancybox.js"></script>
	<script type="text/javascript" src="script/common.min.js"></script>
	<link rel="stylesheet" type="text/css" href="css/960.css" />
	<link rel="stylesheet" type="text/css" href="css/style.css" />
	<link rel="stylesheet" type="text/css" href="css/plugins/tipsy.css" />
	<link rel="stylesheet" type="text/css" href="css/plugins/fancybox.css" />
	<script type="text/javascript">
		$(function(){
			$("select#title-ci").change(function () {
				$('select#title-adult1').val($(this).val());
			});

			$("input#first-name-ci").change(function () {
				$('input#first-name-adult1').val($(this).val());
			});

			$("input#last-name-ci").change(function () {
				$('input#last-name-adult1').val($(this).val());
			});
		});
	</script>
</head>
<body>
	<div class="container_24">
		<header>
			<div class="header-wrapper clearfix">
				<div id="top-bar" class="grid_24">
					<div class="login-box">
						<span class="sign-up-left">
							<a href="register.html" id="register" class="account-modal">Sign Up</a>
						</span>
						<span class="separate-or">
						or
						</span>
						<span class="sign-in-right">
							<a href="login.html" id="login" class="account-modal">Log In</a>
						</span>
					</div>
					<div class="shop-cart">
						<a href="#" title="Your cart is empty"><i class="icon-shopping-cart"></i><sup>0</sup></a>
					</div>
					<div class="search-box">
						<button class="search-trigger"></button>
						<input type="text" id="search_keyword" placeholder="search">
					</div>
				</div>
				<div id="site-logo" class="grid_7">
					<a href="#">
						<img src="img/assets/logo.png" alt="H!Indonesia | Online Tourism Information and Booking Ticket">
					</a>
				</div>
				<nav id="top-nav" class="grid_17">
					<ul id="menu">
						<li><a href="#">home</a></li>
						<li class="drop"><a href="#">book</a>
							<ul>
								<li><a href="#">flight</a></li>
								<li><a href="#">hotel</a></li>
                                <li><a href="#">restaurant</a></li>
                                <li><a href="#">event</a></li>
							</ul>
						</li>
						<li><a href="#">plan</a></li>
						<li><a href="#">explore</a></li>
						<li><a href="#">news</a></li>
						<li><a href="#">travel notes</a></li>
						<li><a href="#">travel guide</a></li>
						<li><a href="#">faq</a></li>
						<li><a href="#">about us</a></li>
					</ul>
				</nav>
			</div>
		</header>
		<section class="main-content grid_19">
			<div class="flight-detail">
				<div class="wrap-flight-detail">
					<?php echo $payment_info ?>
				</div>
				<div class="my-order">
			        <h2>Passenger Details</h2>
			        <div class="wrap-passenger">
			            <div class="desc">
	                        <p>
	                            We need to gather passenger information for you and anyone travelling with you. The names you provide must match the names on the passenger's passport (for international travel) or other acceptable ID (for domestic travel, e.g. driver's licence), which must be presented at check-in. Please provide a mobile phone number for the primary passenger.
	                        </p>
	                    </div>
	                    <div class="already-login">
	                    	<h4>Hi-Indonesia.com Member Login</h4>
	                    	<p>If you already have Hi-Indonesia.com account, you can login to make this process faster.<a class="button login" title="Login">Login</a></p>
	                    </div>
	                    <div class="form">
	                    	<form method="post" action="checkout-confirmation">
	                    		<input type="hidden" value="<?php echo $remark; ?>" id="remark" name="remark"/>
                            	<input type="hidden" value="<?php echo $total_room; ?>" id="total-room" name="total-room"/>
                                <input type="hidden" value="<?php echo $total_pax; ?>" id="total-pax" name="total-pax"/>
                                <div class="contact-person">
	                    			<h4>Contact Person Information</h4>
	                    			<div class="cols clearfix">
				                        <p class="left">
				                            <label for="title-ci">Title<span class="note-required">*</span></label><br>
				                            <select id="title-ci" name="title-ci" tabindex="">
				                            	<option value="Mr">Mr.</option>
				                                <option value="Mrs">Mrs.</option>
				                                <option value="Ms">Ms.</option>
				                            </select>
				                        </p>
				                    </div>
				                    <div class="cols clearfix">
				                        <p class="left grid_8">
				                            <label for="first-name-ci">First Name<span class="note-required">*</span></label><br>
				                            <input type="text" id="first-name-ci" name="first-name-ci" value="">
				                        </p>
				                         <p class="right grid_8 prefix_1">
				                            <label for="last-name-ci">Last Name</label><br>
				                            <input type="text" id="last-name-ci" name="last-name-ci" value="">
				                        </p>
				                    </div>
				                    <div class="cols clearfix">
				                        <p class="left grid_8">
				                            <label for="email-ci">Email<span class="note-required">*</span></label><br>
				                            <input type="text" id="email-ci" name="email-ci" class="email-ci">
				                        </p>
				                        <p class="right grid_8 prefix_1">
											<label for="phone-primary">Phone Number
												<span tooltip="Format: (e.g. +6286665636)" class="star-notice"></span>
												<span class="note-required">*</span>
											</label><br>
											<input type="text" id="phone-primary" name="phone-primary" value="+62" class="phone-number">
											<span class="help-block">Format phone number must begin with your country code.<br> Example: +6221030293.
												<a class="search-code">Search Country Code
													<select id="country-code" class="country-code" name="country-code">
													    <option value="+93">Afghanistan (+93)</option>
													    <option value="+358">Aland Islands (+358)</option>
													    <option value="+355">Albania (+355)</option>
													    <option value="+213">Algeria (+213)</option>
													    <option value="+684">American Samoa (+684)</option>
													    <option value="+376">Andorra (+376)</option>
													    <option value="+244">Angola (+244)</option>
													    <option value="+126">Anguilla (+126)</option>
													    <option value="+672">Antarctica (+672)</option>
													    <option value="+126">Antigua And Barbuda (+126)</option>
													    <option value="+54">Argentina (+54)</option>
													    <option value="+374">Armenia (+374)</option>
													    <option value="+297">Aruba (+297)</option>
													    <option value="+61">Australia (+61)</option>
													    <option value="+43">Austria (+43)</option>
													    <option value="+994">Azerbaijan (+994)</option>
													    <option value="+124">Bahamas (+124)</option>
													    <option value="+973">Bahrain (+973)</option>
													    <option value="+880">Bangladesh (+880)</option>
													    <option value="+124">Barbados (+124)</option>
													    <option value="+375">Belarus (+375)</option>
													    <option value="+32">Belgium (+32)</option>
													    <option value="+501">Belize (+501)</option>
													    <option value="+229">Benin (+229)</option>
													    <option value="+144">Bermuda (+144)</option>
													    <option value="+975">Bhutan (+975)</option>
													    <option value="+591">Bolivia (+591)</option>
													    <option value="+387">Bosnia And Herzegovina (+387)</option>
													    <option value="+267">Botswana (+267)</option>
													    <option value="+47">Bouvet Island (+47)</option>
													    <option value="+55">Brazil (+55)</option>
													    <option value="+246">British Indian Ocean Territory (+246)</option>
													    <option value="+673">Brunei Darussalam (+673)</option>
													    <option value="+359">Bulgaria (+359)</option>
													    <option value="+226">Burkina Faso (+226)</option>
													    <option value="+257">Burundi (+257)</option>
													    <option value="+855">Cambodia (+855)</option>
													    <option value="+237">Cameroon (+237)</option>
													    <option value="+1">Canada (+1)</option>
													    <option value="+238">Cape Verde (+238)</option>
													    <option value="+345">Cayman Islands (+345)</option>
													    <option value="+236">Central African Republic (+236)</option>
													    <option value="+235">Chad (+235)</option>
													    <option value="+56">Chile (+56)</option>
													    <option value="+86">China (+86)</option>
													    <option value="+61">Christmas Island (+61)</option>
													    <option value="+61">Cocos (Keeling) Islands (+61)</option>
													    <option value="+57">Colombia (+57)</option>
													    <option value="+269">Comoros (+269)</option>
													    <option value="+242">Congo (+242)</option>
													    <option value="+243">Congo, The Democratic Republic Of The (+243)</option>
													    <option value="+682">Cook Islands (+682)</option>
													    <option value="+506">Costa Rica (+506)</option>
													    <option value="+225">Côte D'Ivoire (+225)</option>
													    <option value="+385">Croatia (+385)</option>
													    <option value="+53">Cuba (+53)</option>
													    <option value="+357">Cyprus (+357)</option>
													    <option value="+420">Czech Republic (+420)</option>
													    <option value="+45">Denmark (+45)</option>
													    <option value="+253">Djibouti (+253)</option>
													    <option value="+767">Dominica (+767)</option>
													    <option value="+809">Dominican Republic (+809)</option>
													    <option value="+593">Ecuador (+593)</option>
													    <option value="+20">Egypt (+20)</option>
													    <option value="+503">El Salvador (+503)</option>
													    <option value="+240">Equatorial Guinea (+240)</option>
													    <option value="+291">Eritrea (+291)</option>
													    <option value="+372">Estonia (+372)</option>
													    <option value="+251">Ethiopia (+251)</option>
													    <option value="+500">Falkland Islands (Malvinas) (+500)</option>
													    <option value="+298">Faroe Islands (+298)</option>
													    <option value="+679">Fiji (+679)</option>
													    <option value="+358">Finland (+358)</option>
													    <option value="+33">France (+33)</option>
													    <option value="+594">French Guiana (+594)</option>
													    <option value="+689">French Polynesia (+689)</option>
													    <option value="+596">French Southern Territories (+596)</option>
													    <option value="+241">Gabon (+241)</option>
													    <option value="+220">Gambia (+220)</option>
													    <option value="+995">Georgia (+995)</option>
													    <option value="+49">Germany (+49)</option>
													    <option value="+233">Ghana (+233)</option>
													    <option value="+350">Gibraltar (+350)</option>
													    <option value="+30">Greece (+30)</option>
													    <option value="+299">Greenland (+299)</option>
													    <option value="+147">Grenada (+147)</option>
													    <option value="+590">Guadeloupe (+590)</option>
													    <option value="+167">Guam (+167)</option>
													    <option value="+502">Guatemala (+502)</option>
													    <option value="+44">Guernsey (+44)</option>
													    <option value="+224">Guinea (+224)</option>
													    <option value="+245">Guinea-Bissau (+245)</option>
													    <option value="+592">Guyana (+592)</option>
													    <option value="+509">Haiti (+509)</option>
													    <option value="+672">Heard Island And Mcdonald Islands (+672)</option>
													    <option value="+504">Honduras (+504)</option>
													    <option value="+852">Hong Kong (+852)</option>
													    <option value="+36">Hungary (+36)</option>
													    <option value="+354">Iceland (+354)</option>
													    <option value="+91">India (+91)</option>
													    <option selected="selected" value="+62">Indonesia (+62)</option>
													    <option value="+98">Iran, Islamic Republic Of (+98)</option>
													    <option value="+964">Iraq (+964)</option>
													    <option value="+353">Ireland (+353)</option>
													    <option value="+44">Isle Of Man (+44)</option>
													    <option value="+972">Israel (+972)</option>
													    <option value="+39">Italy (+39)</option>
													    <option value="+876">Jamaica (+876)</option>
													    <option value="+81">Japan (+81)</option>
													    <option value="">Jersey ()</option>
													    <option value="+962">Jordan (+962)</option>
													    <option value="+7">Kazakhstan (+7)</option>
													    <option value="+254">Kenya (+254)</option>
													    <option value="+686">Kiribati (+686)</option>
													    <option value="+965">Kuwait (+965)</option>
													    <option value="+996">Kyrgyzstan (+996)</option>
													    <option value="+856">Laos(+856)</option>
													    <option value="+371">Latvia (+371)</option>
													    <option value="+961">Lebanon (+961)</option>
													    <option value="+266">Lesotho (+266)</option>
													    <option value="+231">Liberia (+231)</option>
													    <option value="+218">Libyan Arab Jamahiriya (+218)</option>
													    <option value="+423">Liechtenstein (+423)</option>
													    <option value="+370">Lithuania (+370)</option>
													    <option value="+352">Luxembourg (+352)</option>
													    <option value="+853">Macao (+853)</option>
													    <option value="+389">Macedonia, The Former Yugoslav Republic Of (+389)</option>
													    <option value="+261">Madagascar (+261)</option>
													    <option value="+265">Malawi (+265)</option>
													    <option value="+60">Malaysia (+60)</option>
													    <option value="+960">Maldives (+960)</option>
													    <option value="+223">Mali (+223)</option>
													    <option value="+356">Malta (+356)</option>
													    <option value="+692">Marshall Islands (+692)</option>
													    <option value="+596">Martinique (+596)</option>
													    <option value="+222">Mauritania (+222)</option>
													    <option value="+230">Mauritius (+230)</option>
													    <option value="+269">Mayotte (+269)</option>
													    <option value="+52">Mexico (+52)</option>
													    <option value="+691">Micronesia, Federated States Of (+691)</option>
													    <option value="+373">Moldova (+373)</option>
													    <option value="+377">Monaco (+377)</option>
													    <option value="+976">Mongolia (+976)</option>
													    <option value="+382">Montenegro (+382)</option>
													    <option value="+166">Montserrat (+166)</option>
													    <option value="+212">Morocco (+212)</option>
													    <option value="+258">Mozambique (+258)</option>
													    <option value="+95">Myanmar (+95)</option>
													    <option value="+264">Namibia (+264)</option>
													    <option value="+674">Nauru (+674)</option>
													    <option value="+977">Nepal (+977)</option>
													    <option value="+31">Netherlands (+31)</option>
													    <option value="+599">Netherlands Antilles (+599)</option>
													    <option value="+687">New Caledonia (+687)</option>
													    <option value="+64">New Zealand (+64)</option>
													    <option value="+505">Nicaragua (+505)</option>
													    <option value="+227">Niger (+227)</option>
													    <option value="+234">Nigeria (+234)</option>
													    <option value="+683">Niue (+683)</option>
													    <option value="+672">Norfolk Island (+672)</option>
													    <option value="+850">North Korea(+850)</option>
													    <option value="+670">Northern Mariana Islands (+670)</option>
													    <option value="+47">Norway (+47)</option>
													    <option value="+968">Oman (+968)</option>
													    <option value="+92">Pakistan (+92)</option>
													    <option value="+680">Palau (+680)</option>
													    <option value="+970">Palestinian Territory, Occupied (+970)</option>
													    <option value="+507">Panama (+507)</option>
													    <option value="+675">Papua New Guinea (+675)</option>
													    <option value="+595">Paraguay (+595)</option>
													    <option value="+51">Peru (+51)</option>
													    <option value="+63">Philippines (+63)</option>
													    <option value="+870">Pitcairn (+870)</option>
													    <option value="+48">Poland (+48)</option>
													    <option value="+351">Portugal (+351)</option>
													    <option value="+787">Puerto Rico (+787)</option>
													    <option value="+974">Qatar (+974)</option>
													    <option value="+262">Réunion (+262)</option>
													    <option value="+40">Romania (+40)</option>
													    <option value="+7">Russian Federation (+7)</option>
													    <option value="+250">Rwanda (+250)</option>
													    <option value="+590">Saint Barthélemy (+590)</option>
													    <option value="+290">Saint Helena (+290)</option>
													    <option value="+186">Saint Kitts And Nevis (+186)</option>
													    <option value="+175">Saint Lucia (+175)</option>
													    <option value="+159">Saint Martin (+159)</option>
													    <option value="+508">Saint Pierre And Miquelon (+508)</option>
													    <option value="+178">Saint Vincent And The Grenadines (+178)</option>
													    <option value="+685">Samoa (+685)</option>
													    <option value="+378">San Marino (+378)</option>
													    <option value="+239">Sao Tome And Principe (+239)</option>
													    <option value="+966">Saudi Arabia (+966)</option>
													    <option value="+221">Senegal (+221)</option>
													    <option value="+381">Serbia (+381)</option>
													    <option value="+248">Seychelles (+248)</option>
													    <option value="+232">Sierra Leone (+232)</option>
													    <option value="+65">Singapore (+65)</option>
													    <option value="+421">Slovakia (+421)</option>
													    <option value="+386">Slovenia (+386)</option>
													    <option value="+677">Solomon Islands (+677)</option>
													    <option value="+252">Somalia (+252)</option>
													    <option value="+27">South Africa (+27)</option>
													    <option value="">South Georgia And The South Sandwich Islands ()</option>
													    <option value="+82">South Korea(+82)</option>
													    <option value="+34">Spain (+34)</option>
													    <option value="+94">Sri Lanka (+94)</option>
													    <option value="+249">Sudan (+249)</option>
													    <option value="+597">Suriname (+597)</option>
													    <option value="+47">Svalbard And Jan Mayen (+47)</option>
													    <option value="+268">Swaziland (+268)</option>
													    <option value="+46">Sweden (+46)</option>
													    <option value="+41">Switzerland (+41)</option>
													    <option value="+963">Syrian Arab Republic (+963)</option>
													    <option value="+886">Taiwan, Province Of China (+886)</option>
													    <option value="+992">Tajikistan (+992)</option>
													    <option value="+255">Tanzania, United Republic Of (+255)</option>
													    <option value="+66">Thailand (+66)</option>
													    <option value="+670">Timor-Leste (+670)</option>
													    <option value="+228">Togo (+228)</option>
													    <option value="+690">Tokelau (+690)</option>
													    <option value="+676">Tonga (+676)</option>
													    <option value="+868">Trinidad And Tobago (+868)</option>
													    <option value="+216">Tunisia (+216)</option>
													    <option value="+90">Turkey (+90)</option>
													    <option value="+993">Turkmenistan (+993)</option>
													    <option value="+649">Turks And Caicos Islands (+649)</option>
													    <option value="+688">Tuvalu (+688)</option>
													    <option value="+256">Uganda (+256)</option>
													    <option value="+380">Ukraine (+380)</option>
													    <option value="+971">United Arab Emirates (+971)</option>
													    <option value="+44">United Kingdom (+44)</option>
													    <option value="+1">United States (+1)</option>
													    <option value="+1">United States Minor Outlying Islands (+1)</option>
													    <option value="+598">Uruguay (+598)</option>
													    <option value="+998">Uzbekistan (+998)</option>
													    <option value="+678">Vanuatu (+678)</option>
													    <option value="+379">Vatican City State (+379)</option>
													    <option value="+58">Venezuela (+58)</option>
													    <option value="+84">Viet Nam (+84)</option>
													    <option value="+128">Virgin Islands, British (+128)</option>
													    <option value="+134">Virgin Islands, U.S. (+134)</option>
													    <option value="+681">Wallis And Futuna (+681)</option>
													    <option value="+212">Western Sahara (+212)</option>
													    <option value="+967">Yemen (+967)</option>
													    <option value="+260">Zambia (+260)</option>
												    </select>
												</a>
											</span>
				                        </p>
				                    </div>
	                    		</div>
	                    		<?php echo $adult ?>
			            		<?php echo $children ?>
	                    		<div class="adult-passenger">
		                    		<div class="continue clearfix">
	                                    <a href="#" id="button-ec">Add to shopping cart</a>
	                                    <input type="submit" value="Pay Now" id="continue-book" class="button">
	                                </div>
	                            </div>
	                    	</form>
	                    </div>
			        </div>
				</div>
			</div>
		</section>
		<section class="sidebar-right grid_5">
			<div class="ads-space">
				<a href="#"><img src="img/static/ads-denpasar.png" alt="Ads space"></a>
				<a href="#"><img src="img/static/ads-lombok.png" alt="Ads space"></a>
				<a href="#"><img src="img/static/ads-google.png" alt="Ads space"></a>
			</div>
		</section>
		<footer>
			<nav class="clearfix">
				<ul class="bottom-nav grid_24">
		          <li><a href="#">About Us</a></li>
		          <li><a href="#">FAQ</a></li>
		          <li><a href="#">Contact Us</a></li>
		          <li><a href="#">Jobs</a></li>
		          <li><a href="#">Our Partner</a></li>
		          <li><a href="#">Press</a></li>
		        </ul>
	        </nav>
	        <section class="footer">
	        	<div class="footer-wrapper clearfix">
		        	<div class="footer-left grid_12">
		        		<ul>
		        			<li><a href="#">Terms of service</a></li>
		        			<li><a href="#">Privacy</a></li>
		        			<li><a href="#">Feedback & support</a></li>
		        		</ul>
		        		<div class="copyright">
		        			&copy; 2013 Hi-Indonesia. All rights reserved.
		        		</div>
		        	</div>
		        	<div class="footer-right grid_12">
		        		<ul>
		        			<li><a href="#">English</a></li>
		        			<li><a href="#">Bahasa</a></li>
		        		</ul>
		        	</div>
	        	</div>
	        </section>
		</footer>
	</div>
</body>
</html>